50 comments:

A misleading statistic. When you start severely curtailing deaths from assorted diseases that used to kill millions each year, something has to go up on the list as "most common killer" --- even if it kills few people.

The death rate is constant--one each. Something, in the end, will get us all. As damiksec points out, as we get better and better at treating the big ones, other issues begin to loom larger. Patients are kept alive in ever frailer states such that smaller insults have grave consequences. A mistake that would hardly be noticed in a healthy person may be fatal in someone who is already at death's door.

Which is not to say that medical error shouldn't be an issue as we strive to squeeze more years out of our bodies, but don't read too much in to it. This is not evidence we are facing a crisis of lethal carelessness among our doctors.

Both abortion and plastic surgery are done primarily to increase the sexual power of women and make them more attractive to mates. "What baby? I don't have a baby. What cellulite? I don't have any cellulite."

And the other reason these elective surgeries are done is to put money in the pocket of the doctor who does them.

Notice too that our mainstream media will not run photographs of aborted babies or plastic surgery disasters.

Hide the bad! Hide the awful! Don't let people see the truth! It's the unofficial motto of our so-called Fourth Estate, possibly the most embarrassing branch of our government. Journalists are wannabe members of the state. It's why they hide photographs of war atrocities, too. Protect the state! Hide the truth!

Doctors are human. They have to make decisions and they guess a lot. The real complaint should be how easy it is for them to escape accountability for causing injury because other MDs will cover for them.

And in most states the last 20 years our traditional Med Mal system of accountability that used give the MDs feedback has been 90% eliminated by Tort Reform Laws sold to dumb Conservatives as if it does a noble reform, while it is actually an evil abuse of the destroyed victims that was enacted by paid for politicians under false claims that it reduces Medical costs.

I notice that firearms didn't make the top 10 as a cause of death. Imagine that. Makes me wonder why the CDC is pushing doctors to ask about firearms in the home when doctors are actually more dangerous.

We have a government control trying to remedy this, the Affordable Care Act (Obamacare) in addition to measures taken by Medicare administrators and a host of others at both the state and federal level. One of the problems is that there is a conspiracy of silence brought on by the courts who usually mandate a gag order on all successful medical malpractice lawsuits/settlements in addition to the fact that many of these deaths are inadvertent or accidents due to preventable causes such as fatigue, lack of information or situations such as hangovers in ERs. (My son is an ER doctor.). Doctors are reluctant to be involved lest they get caught up in the legal entanglements.Things are being done and this is a real problem, but there is not a single answer to a complex issue. This is not news, we have known about it for years, and while the metric of third place (9.7 percent of all deaths each year - gun deaths, in all forms account for 2.3 percent, well below a a lot of other causes) is intriguing, it is not a single treatable cause in the same way cancer and heart disease are. In fact, for the most part it isn't even medical, it is process gone wrong. There are ways to diminish the numbers that require standardized techniques (infections are fewer due to such measures) and a "why" approach that looks for such answers but this is more in the realm of safety and industrial efficiency than medicine. If we are going to gather the information, who else but a central organization is going to gather it? There are 900,000 beds in 6000 hospitals in this country (not to mention beds in nursing homes) and the potential for mistakes is high. There have to be ways to decrease these problems to a minimum (which may still be high depending on your meaning of high) that can be parsed out by looking at a large data base. No one but the government will be able to gather this data since it has the power (money, it pays for 43% of medical care) and the mandate (public safety) to do so. The Feds and states already have the power to shut down hospitals and they control the safety of medicines and devices. They are already in the business and are aware of the problems of hospital deaths - there are published reports of safety and cost available now for your perusal if you can find them on line. I'm a retired physician now on the patient side of things. I am fully aware of the problems in hospitals and I know that there are measures being taken to alleviate them but it is a hard task and the main actors who are interested in making things better often don't have the time or the knowledge to act unless there is a culture of caring in the hospitals that may have to mandated. There's plenty of money to do it - a non-profit hospital in WI made over $300,000,000 in profit last year - but this kind of change is a lot of work that can only be done by a few, mostly hospital administrators and hospital executive committees mandating these things. Nothing motivates these people more than a government entity breathing down your neck. Lawsuits are not going to do it.

And yet these docs have so much time that they want to waste precious minutes discussing our personal firearms storage policies. Thanks doc, but I was in the military for longer than you were in med school. Stick to your knitting.

As a medical professional who routinely witnesses poor clinical practice to prevent the spread of disease/infection, and as a medical researcher who is involved in lots of research studies, I think this study is not an actual study. Even calling it a meta-analysis is going too far.

This "research" published in the BMJ is two authors at Johns Hopkins looking at other studies and giving them a weighted average. Those other studies? They didn't directly measure preventable death either. For example, one of the most recent studies they heavily relied upon looked at "medication stop orders" and "abnormal lab results" and if the end result was death, they considered that preventable. That's a terribly inaccurate way to assess preventable death - medication could be stopped because it's not working, or due to allergic reaction, or because a better combination of medications was identified. Sometimes the medication would be stopped BECAUSE it generated abnormal lab results, and if the patient later died, that's a "medical death".

In other words, this study does not actually MEASURE preventable deaths. It simply uses various things that happen during the care continuum to suggest the death may have been preventable, which is completely useless way of trying to measure.

And they use the fact that others have measured medical death in the same manner as a cover for them doing it and to build the case for such research as being a reasonable way to measure medical death.

Further, what they published in the BMJ was not research - it was a policy suggestion. If you read it, it's pure policy not pure research.

Shame on them, and shame on Johns Hopkins who has a better reputation than this.

I was doing some work with H-P about 15 years back on a scanner to read patient wristbands and the medication and alarm if they didn't match.

One of the surprising things I learned was that 20-40,000 people per year die in hospitals because of getting the wrong medicine. Not because the wrong medicine was prescribed. That causes additional deaths. This was because the patient got 2 tablets instead of 1 or vice versa, Mr Jones got Ms Smith's medication and so on.

Yeah, sounds like a high number to me too but it seemed to be well documented.

Holdfast, I doubt you were in the military longer that I was (28 years) so I'll let you do the knitting. But I rarely talked firearms with my patients unless they read one of my articles in Shotgun Sports Magazine.

TreeJoe, I agree that there is a lot wrong with that study, the first thing being that it really doesn't look at the issue (which you have to admit is there, in fact your experience seems to verify it when you mention poor infection control practices, something I saw a lot of too), but what other way do we have to define what is going on? Part of this has to do with the lack of data and the some has to do with the lack of motivation to give up that data. The hospital I worked at has been trying to change using what data and (especially) the practices either mandated or recommended and the results have been promising but it was only until a younger more interested coterie of physicians took over the executive committee that it happened (and they were told to do so by the joint commission.). I'm not so sure that policy is a bad thing but I agree that touting it as a research paper is a good thing, but we physicians have never been known for publishing rigorous research.

David Begley, The market is efficient, for lawyers. Medical malpractice is hard to prove and the patient has to have the knowledge to be motivated to sue in the first place. Most cases are settled and they tend to be settled due to the nuisance factor and the fact that there is a slush fund in every state to cover large awards. Since malpractice suits rely on a large upfront investment by the suing lawyer, only those that are slam dunks (injured babies, for instance) or have a good chance, go to court. The rest are either settled or the patient is paid off in order to avoid any litigation.

Are we sure that the reason medical errors are rising closer to the top of the list is that there are more than there used to be? Or could the reason be that medicine is generally IMPROVING, so that good care is decreasing other causes of death? Could it be that there are fewer deaths from kidney disease and stroke and diabetes than there once were, because medicine is learning how to keep more of those people alive, and so those things are moving down the list while medical errors, heart disease and cancer are what's left?

No knowledge here -- I'm not in medicine and no expert in medical statistics. Just wondering if it's possible that this isn't what it appears to be.

We also need to bear in mind that sooner or later, everybody has to die of SOMETHING. For instance, my mother's death was hastened by a medical error in treating a complication of her final illness. But she was also 83 and suffering from a whole host of serious medical problems, any one of which would certainly have done for her soon, if the one that did hadn't happened.

We have no "slush funds" for medical malpractice litigation. None. I have no idea what you are referring to. We have a state bar dues-funded program, which is tiny, for rare cases of legal malpractice harm in which a victim's losses are uninsured. And any time that fund is tapped, it is pretty much assured that the lawyer will be suspended from the practice for a year, or more, and perhaps permanently disbarred.

Also; never once in thirty years have I seen a trial court "mandate" a gag order on a settlement. There is almost never such an order at all, and when they are imposed in rare, highly specialized cases, they are usually resisted by the judge. No, mike; confidentiality agreements are a standard part of the mutual, voluntary settlement agreements between parties. Standard, in almost all of civil litigation.

If you or anyone else have any particular questions about tort reform -- I have been involved in appellate-level defense of some if Michigan's tort reform provisions -- I may be able to shed some light.

Birth trauma litigation is what made Jihn Edwards a millionaire many times over. Those cases are almost never "slam dunks" and in the freakishly rare event that there is a slam dunk cause if action, they are settled quickly and for huge amounts.

The typically-litigated birth trauma case is where liability is very thin (the baby's developmental problems are due to no known cause, or a cause unrelated to labor and delivery), but the damages (such as lifetime 24-hour care, loss of cognitive function and any ability to procreate) are huge. And those particular elements of a damage claim are not limited under most tort reform schemes.

I just wanted to correct that misperception or mis-wording on your part.

Perhaps "slush fund" is the wrong term, but I used to pay $640/year to a fund for medical malpractice relief (for patients) that was used when a patient's award exceeded some standard. I don't have a problem with the fund or patients suing but a lot of doctors do as do hospital administrators who want their records to be clean. This is one of the problems (not the lawyers suing, or even the patients suing), the hidden nature of mistakes including malpractice. As you know, malpractice has to meet certain criteria which are usually much more stringent than just a mistake and that criteria should be proven through a variety of means in court. I probably should not have used the word "mandate" either, but as you point out, confidentiality is a common part of civil suits and that confidentiality makes gathering information hard. It is an inadvertent part of the legal process that has unexpected consequences (and not a plot on lawyers part) as far as the gathering of data goes.

One of the things that gathering data would do is to parse out the differences between malpractice, accidents, and unexpected results or side effects and make it easier to determine what steps can be taken to decrease the incidence of these events. Look at the FAA or Apple, they want everything reported so they can find ways to make things better and safer. It works for them but there are still problems. Just think of the problems that would occur if they didn't.

One good example is the how the cost of malpractice insurance went down for anesthesiologist once they put in to place standard practices for anesthesia 20 or so years ago. This reform was driven by the numbers that the insurance companies put out. They knew what was going on and professional body for anesthesia demanded changes as did the joint commission. The results were such that the cost if malpractice insurance went way down as the safety factor went up.

Doctors don't like malpractice lawyers (I am sure your doctor is a personal friend) but the system is a plus for physicians in the long run because it forces changes that may decrease malpractice. But that's malpractice, the error issue is different and does not yet have enough information to generate the motivation to change - however that is beginning to happen due to a number of factors. This paper, with all of its flaws and probable errors, is just a symptom of the problem. The full answers are yet to come and I am sure no one wants the status quo to remain.

I see you practice defense, my bad. I'm sure you have doctors who are not personal friends . I am from Tennessee where John Edwards made his money. I didn't like him then either.

I may be wrong, but there was a time when and OB/GYN physician could be expected to be sued at least five times mostly due to the birth of an injured baby. Perhaps that has changed due to better science in the courts. I hope so.

I just went to a general practitioner with a medical problem. I had self diagnosed myself. The general practitioner thought it was something else entirely and something way more scary. He advised me to immediately go see a specialist. It took the specialist a moment to confirm I was right and the general practitioner was wrong. Ugh!!!

I've also had a dermatologist misdiagnose something and prescribed medicine that made me unbelievably sick. I think he had done some drinking at lunch that day or was just incredibly sleepy.

NE has a med mal liability cap. Iowa does not. Med mal insurance way, way more expensive in Iowa. And many more lawsuits. Nebraska doctors are not that much better than Iowa doctors and the lawyers on both side of the river are the same.

Mikeyes, as someone on the inside I think the medical malpractice system is a racket that is ripe for much more, not less, tort reform. But the bar associations, in conjunction with Democrats, oppose all of it.

This is an area where I side with my political party -- Republicans are the one and only tort reform party -- over my professional association(s). Over, as it turns out, my own financial interest. The filing of 30,000 new meritless med mal suits would be great for me. And basically no one else.

I like the idea of tort reform and I agree that without it there is no incentive to practice medicine in a state that has none. Medicine is the ultimate portable profession and there are plenty of opportunities elsewhere - my wife and I moved twice because we got paid better. That may be the policy issue that enables states to keep their high risk specialists. If I remember correctly, FL had this problem with OB docs years ago.

But malpractice is not the issue, errors, mistakes, and poor practice is in hospitals, outpatient clinics and other venues where health care workers practice is. It's called practice for a reason as it probably takes ten years after residency to develop the heuristic chops to be a very good doctor and some never do. And the solutions offered by some authorities are done so on incomplete information. This has been a common problems in medicine (working with incomplete information) since the concept of care started and we still make diagnostic and treatment mistakes. No one can keep up with the firehose flood of information about the science of medicine much less the practice of medicine but we can have standard practices based on what information we have, we can use common sense and not let physicians work beyond capacity, and we can have environments that limit how much damage can be done. We are not even close to that latter point yet and we need the information to develop such environments.

BTW, David Begley, do you have relatives in the West Kerry region of Ireland? There is a famous family of Irish musicians there.

Mike I once represented the Chairman of an OB-Gyn department. His next job after that was Dean of a medical school. He was board certified. A national super-expert in Maternal-Fetal medicine and high risk pregnancies.

He had been named a defendant in 13 malpractice actions when he was my client. I expect that count later increased.

He was not negligent in my case. I expect he wasn't negligent in any of the others. The reason he was sued so much was because his teaching hospital took on all of the ultra-complicated cases (referral, and indigent) from the underclass population of Detroit. And because his cases were filed by plaintiffs in the litigation hellhole of Wayne County. Where civil juries were notoriously hostile to hospitals and other institutional defendants. And sometimes outrageous in awarding damages. The undercurrent in every Wayne County settlement us that nobody could know when a jury might award a seven- or eight-figure judgment.

In my business, I frequently need to depose docs in the Medical Examiner's office. And it is truly frightening. I realize that their most important testimony comes in homicide cases. And there, maybe the cause of death or the mechanism of injury is easy.

But the pathologists in ME practice are utterly -- and by law -- unqualified to render any opinions on the relevant standard of care in any given case. They don't even do autopsies on most hospital deaths.

My best professor at Creighton Law School frequently talked about legal conclusions. One of the most valuable things I learned in law school. Professor Ron Volkmer is his name. Just retired. Taught property and wills.

This outrages me because it's getting so much press and just encourages distrust of the established medical community - which has earned some distrust, don't get me wrong. But not "3rd leasing cause of death" distrust.

Truly preventable medical deaths are better examples such as nosocomial infection (i.e. MRSA, ,C.Diff), and other measurable problems with interacting with the medical community. A very solid CDC study indicated that hospital-acquired infection killed 75,000 in 2011 - which would still be a huge number of deaths due to simply going to a hospital.

But the focus should be on those things directly measurable and, to a large extent, preventable. Not "medical error" labeling.

Reactive parenthood (i.e. abortion rites) and clinical cannibalism (i.e. planned parenthood) take over one million [wholly innocent] human lives annually. They are the leading cause of mortality in the first year of human evolution.

How would you like to be a relative of a person who died and the reason listed was "medical error?" That person would hate and resent the doctors, nurses and hospital forever. I have no idea about med mal cases in other countries but my sense is that they are few.

n.n said...The medical oath, along with science, were inconvenient truths that obstructed progress.

Aww, you left out the best part:

"I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract: ...I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft."

Back then the oath probably should've been "I won't do anything to anybody" because -